PEDIATRIC UROLOGY

Lymphatic-sparing laparoscopic varicocelectomy versus microscopic varicocelectomy: is there a difference?
VanderBrink BA, Palmer LS, Gitlin J, Levitt SB, Franco I
Division of Pediatric Urology, Schneider’s Children Hospital, New Hyde Park, New York, USA
Urology. 2007 Dec;70(6):1207-10

• Objectives: The ideal operation for the adolescent varicoceles has been debated for many years as new techniques or advances in existing technology develop. It is well acknowledged that the Palomo procedure has a negligible recurrence rate but a very high postoperative hydrocele rate compared with a microscopic varicocelectomy (MV). We sought to determine whether lymphatic-sparing laparoscopic varicocelectomy (LSLV) could provide similar negligible recurrence rates as the Palomo approach with the negligible postoperative hydrocele rate seen with MV.
• Methods: We performed a retrospective chart review of patients who underwent either an MV (n = 31) or LSLV (n = 28). In the MV group, the artery and the lymphatics were spared, whereas in the LSLV group, the artery and veins were taken en masse. Statistical analysis included paired Student t-test and Chi-square test for continuous and categorical variables, respectively.
• Results: Preoperative testis volumes were not different nor were the postoperative testis volumes between groups. Mean operating time was significantly longer in the MV than the LSLV group (140 minutes versus 51 minutes, P <0.01). With a mean time since surgery of 2 years, we observed only one patient with a recurrent varicocele (MV group); only one patient developed a hydrocele requiring hydrocelectomy (LSLV group).
• Conclusions: Our early data indicate that LSLV and MV are comparable in preventing varicocele recurrence and formation of hydroceles. The primary difference between the procedures is the surgical time, with the LSLV being much faster to perform.
  
  
• Editorial Comment
  This study is a comparison between 31 patients with a microscopic varicocelectomy technique in 28 patients with a lymphatic-sparing laparoscopic varicocele technique over a 28-month period. Indications for the surgery were either pain or testicular hypotrophy defined as a 20% volume difference between testicles. Postoperative checks were at one week, six months and every 6-12 months thereafter. Testicular ultrasounds were encouraged postoperatively. Age and grade of varicoceles and bilateralism were not statistically significant between the groups. There were no immediate postoperative complications. There were no testis volume differences postoperatively on the 64% of patients who had ultrasounds and the left testis volume increased postoperatively in both groups. Only one recurrent varicocele was seen in the microscopic group and none in the laparoscopic group. There was one patient in the laparoscopic group who developed a hydrocele postoperatively that has subsequently been repaired.
  Several techniques reported in the literature correct varicoceles. The microscopic technique has had the lowest varicocele recurrence and hydrocele development rates. This study shows that a laparoscopic lymphatic-sparring technique has as good of results as the microscopic group. It is good to know that the laparoscopic technique can have similar success rates and the major advantage of the laparoscopic technique in the study is shorter operating times by an hour-and-one-half. It may be that in the future laparoscopic techniques may be more familiar to urologists than the microscopic techniques, but only time will tell.

Dr. Brent W. Snow
Division of Urology
University of Utah Health Sci Ctr
Salt Lake City, Utah, USA